The Step Exams

Part of Medical School. Which exam actually carries a number now, the resources people use and what they cost, the four things that make studying for these different from studying for the MCAT, and what a dedicated study period does to a household that needs your income.

The short version

Step 1 has been pass/fail since January 2022.1 A great deal of advice still circulating was written when it carried a three-digit score, and it is wrong in a way that will cost you effort in the wrong place.

Step 2 CK carries the number now, which moves the high-stakes exam later, into the year when you also have clerkships, away rotations, and an application to build.

The exams are the cheap part. Registration is a few hundred dollars each. The question banks, practice exams, and video subscriptions people actually use run to several times that.

The dedicated period is the real cost. Four to eight weeks of full-time study with no income, at a point where you cannot pick up shifts, is the part that is hardest on a student whose family is leaning on them.

There is fee assistance, and it is capped. The NBME and National Medical Fellowships cover the full $695 registration for Step 1 or Step 2 CK for more than 1,400 students a year on demonstrated financial need. You apply after you have taken the exam, in one of two windows, so check the dates before you pay full price for anything.2

The pass/fail change moved the pressure rather than removing it

When Step 1 was scored, it was the single number that sorted residency applicants, and the whole first two years bent around it. That ended for exams taken from 26 January 2022, and Step 1 now reports only pass or fail.1

This was meant to reduce pressure. What it actually did was move it.

Programs still need a way to sort thousands of applications, so the weight shifted to Step 2 CK, which is still scored. The consequence is a change in timing that matters more than the change in stakes: the exam that carries your number now sits after the preclinical years, in the same stretch as clerkship grades, away rotations, and the application itself.

A failed Step 1 is still a serious event. Pass/fail means there is no reward for a high score. It does not mean the exam is low-stakes. A fail is reported, and it is one of the few things that closes doors mechanically.

The rest of your file matters more than it used to. With one fewer number to sort on, programs lean harder on clerkship grades, letters, research, and school reputation. Several of those are less transparent and more relationship-driven than a test score, which is why Clerkships is the page beside this one.

Advice ages badly here. If a study plan, a forum thread, or an upperclassman's spreadsheet assumes a Step 1 score, it predates 2022 and its priorities are wrong for you. Check the date on anything you are handed.

The method is the MCAT's method, and four things are different

The site already teaches how to study for a long standardized exam, in depth, for the MCAT. That work transfers almost completely and this page is not going to repeat it. Active recall over rereading, spaced repetition run daily, a question bank used as feedback rather than as a score, timed blocks, and a review process that is longer than the block itself. If you want the method, The Study Plan, The Practice Lab and Anki & Spaced Repetition are the three pages, and they were written to be read twice.

What is genuinely different needs stating precisely, because it is where MCAT habits mislead people.

The objective changed for Step 1, and most study plans have not caught up. Pass/fail means you are clearing a bar rather than maximizing a number. That is a different optimization. On the MCAT, the last ten points were worth grinding for. Here, effort spent pushing well past a comfortable pass is effort not spent on the clerkship year that now carries your grades, and on the exam that now carries your number. Study to pass Step 1 comfortably, then stop.

The NBME self-assessments are the calibration instrument, and they are the closest thing to a real answer. These are retired-question practice exams sold by the people who write the real one, at roughly $62 a form, and they report a score predicting your performance. Most schools require at least one before they will let you schedule. The way experienced students use them is not as practice but as a decision procedure: take one early to find out where you actually are rather than where you feel you are, take another about a week out, and let the second one decide whether you sit the exam or move it. The free 120-question sample on the USMLE site is the closest available approximation of the real interface and is worth doing under real conditions.

Your shelf exams are Step 2 practice. The NBME subject exam at the end of each clerkship is written by the same organization, in the same register, from the same material. Which means third year is already a Step 2 study plan that runs for a year, and the students who treat each shelf as its own disposable hurdle do the work twice. Studying for a shelf properly is studying for Step 2 CK. UWorld's Step 2 product bundles shelf review into the same subscription for exactly this reason.

The deadline is external, and it is the constraint people discover late. For the 2027 season, applicants submit on 2 September and programs begin reading on 23 September.3 The USMLE says results are "typically available two to four weeks after your test date" and, in the same document, that you should "allow at least eight weeks" before expecting a score report.4 Work backwards from that. A Step 2 CK date in late July is comfortable; mid-August is tight; September means applying with the score pending, which some programs will treat as an incomplete application. This is the single planning fact on this page most likely to change what you do, and the eight-week figure comes from the USMLE's own bulletin rather than from anybody's study plan.

The resources people actually use

Named for the same reason the preclinical page names its stack: a student with a physician at home gets these in a text message, and withholding them only penalizes everyone else. Prices were read from the vendors' own pages on the date at the foot of this page. None of this is a recommendation to buy anything.

Most of the stack carries over from preclinical. First Aid, Pathoma, Sketchy, Boards & Beyond and the AnKing deck are the same products, priced and described on Surviving the Preclinical Years. If you built that stack in first year, you mostly already own what you need, which is the strongest financial argument for buying one long subscription early, since two short ones cost more.

UWorld is the question bank both exams are built around. Step 1 and Step 2 CK are sold separately, each at $349 for 30 days, $459 for 90, $519 for 180 and $579 for 360. Amboss is the main alternative and some schools license it institutionally, which is worth asking before you buy either.

NBME self-assessments, roughly $62 a form, several forms available, bought individually.5 Budget for three or four. NBME runs periodic bundle discounts.

The free material is not a consolation. The USMLE's own practice materials, including the 120-question sample for each Step, cost nothing and come from the source. Doing them properly is not a poor-student version of preparing.

Two cautions on the whole list.

Prices and product structures move, and the review-phase purchases are the ones that cluster and hurt. Check before you buy and look at the money section below first.

Buying more of it is the most common substitute for using any of it. Two resources finished beats five sampled, which is the same rule as first year and is broken most often in the six weeks before a Step exam.

What this actually costs

Nobody gives you a total, so here is how the total is built.

Registration. Each Step exam costs roughly $700: for 2026, Step 1 and Step 2 CK are $695 each, and Step 3 is $955.2 If you are an osteopathic student, see the next section, because your version of this line is doubled.

Question banks. Priced by duration, sold per exam, and usually the largest single line. The numbers are in the section above. The standard mistake is buying a short window twice.

Practice exams. The NBME self-assessment forms, individually. Most people take several, and most schools require at least one before they will let you schedule.

Video or flashcard subscriptions, if you use them, are another annual or semester-length cost on top, and are mostly the preclinical stack you may already own.

A commercial prep course is the optional line, and it is the expensive one. It can cost more than everything above combined.

Add those and the resource stack routinely costs more than the exams do, sometimes by a wide margin. That lands better at the start of second year than six weeks before you test, because the cheapest version of every decision above is available only if you plan it early.

If you are a DO student, the arithmetic is worse

Osteopathic students take COMLEX, which is their licensing sequence. Many also take the USMLE, because a number of residency programs are more familiar with it, and because the single-accreditation system did not make program-level preferences disappear.

Which means two exam sequences, two registration fees, and preparation that overlaps but is not identical. That is a real financial and time cost carried by students who, on average, are already paying more for their education.

Decide deliberately. Ask your school and, better, ask residents in your intended field whether taking both is genuinely expected there. In some specialties it plainly is. In others it is folklore that costs a thousand dollars.

The dedicated period is the part that hurts

Most schools give you a protected block before Step 1, commonly four to eight weeks, with no classes and no clinical duties. Everyone talks about it as a study problem. For a lot of readers of this site it is a money problem.

You cannot work during it in any meaningful way. Rent does not pause. If anyone at home depends on what you bring in, that dependence does not pause either. And it lands at a point in the year when a term's loan disbursement may already be spent.

Four things to do about it, in the order that helps most.

Plan the cash for it a term ahead, not a month ahead. This is a foreseeable expense and it is the single most predictable cash crunch of the preclinical years.

Ask the financial aid office whether the dedicated period is inside your cost of attendance. Sometimes it is not counted properly, and a cost-of-attendance adjustment is the mechanism for fixing that. The Summer Before Day One explains how that appeal works.

Ask about the school's emergency or hardship fund before you need it. Most schools have one and it is usually run out of student affairs, which is why people looking in the obvious place never find it.

Do not solve it with a credit card if any of the above is available. A card balance compounds at two to three times a student loan's rate and carries none of the protections, and The Money is the pillar that takes that arithmetic seriously.

Whether to buy a course

The honest answer is that most people do not need one, and that the people who most often buy one are the people least able to afford it.

A commercial course sells structure and reassurance. Both are real products. But the material in them is the material in the question bank you were going to buy anyway, and the structure is something your school's own schedule and a calendar can supply.

Where a course earns its price: if you have failed a practice exam badly and cannot work out why, if you have a documented learning difference and the course provides accommodation the free options do not, or if your school's curriculum is genuinely out of step with the exam and upperclassmen say so consistently.

Where it does not: buying it in advance, before you have taken a single practice exam, because it feels like insurance. That is the version to avoid, and it is the version the marketing is aimed at.

Ask your school what it already pays for. Many schools license a question bank or a set of practice exams institutionally and do not advertise it well. That is a free version of the largest line in the previous section, and asking costs nothing.

Accommodations have a long lead time

If you have a disability or a documented condition, testing accommodations are requested from the USMLE or NBME directly rather than from your school, and the process takes months. Your school's disability services office is where the documentation comes from, but it does not grant the accommodation.

Start early. This is the same warning Prerequisite Planning gives about the MCAT and Taking a Leave gives about clinical schedules, and it applies here with the most force, because the exam date is tied to a school-set block you cannot easily move.

If you had accommodations on the MCAT, that history helps and does not carry over automatically. You apply again.

What the score is actually used for

Programs use Step 2 CK as one screen among several. The honest source for what that means in a given specialty is the NRMP's Charting Outcomes in the Match, which reports what matched and unmatched applicants actually presented, by applicant group, including Step 2 CK.6

Read that, because forums systematically overstate the profile of a successful applicant. The person posting a 265 is posting because it is a 265. The people at the median are not posting at all.

What belongs to other pages

How clerkship grades work, which now carry more weight than they used to, belongs to Clerkships.

How specialty competitiveness is actually composed, of which board scores are one of four parts, belongs to Choosing a Specialty.

The method in full, which the site teaches for the MCAT and which transfers with the four exceptions above, is The Study Plan, The Practice Lab and Anki & Spaced Repetition.

The resource stack you were already buying in first year, with its prices, is Surviving the Preclinical Years.

The arithmetic of paying for any of this belongs to The Money.

Where this fits on the Road

These exams sit inside the four years, and studying early is not the useful early move. Find out what your school already pays for, get any accommodation request moving, and put the dedicated period in your budget the term before it arrives.

If you take one thing from this page beyond the money: work backwards from 23 September. The Step 2 CK date that leaves your score in the application when programs start reading is earlier than most people assume, and it is the one deadline here that nobody sends you a reminder about.

Exam formats, registration fees, score reporting windows, ERAS dates, accommodation processes, and commercial resource pricing all change, and several of them change annually. Resource prices were read from the vendors' own pages on 2026-08-11 and will date faster than anything else here. Naming products describes what students use and implies no endorsement. Confirm current details with the USMLE, the NBME, the NBOME for COMLEX, ERAS, and your own school before planning around anything here. Educational information, not advice. Reviewed quarterly. — Last reviewed: 2026-08-11

References

Footnotes

  1. USMLE Step 1 moved to pass/fail-only score reporting for examinations taken on or after 26 January 2022; examinees testing on or before 25 January 2022 received a numeric score. Verified 2026-08-03. Step 2 CK continues to report a numeric score. https://www.usmle.org/usmle-step-1-transition-passfail-only-score-reporting ↩ ↩2

  2. USMLE examination fees for 2026: Step 1 $695, Step 2 CK $695, Step 3 $955, set annually. ⟳ https://www.usmle.org/apply-exams · Step 3 fees are published by the FSMB: https://www.fsmb.org/step-3/step-3-application-fees/ . The NBME Fee Assistance Program for USMLE, administered with National Medical Fellowships, awards $695 toward Step 1 or Step 2 CK registration to more than 1,400 students a year. Eligibility requires US citizenship, permanent residence or DACA approval, enrollment at an LCME- or COCA-accredited school, demonstrated financial need, and having taken the exam within the calendar year before the application window closes. The 2026 cycles ran 13 July to 23 August 2026 and 23 November 2026 to 10 January 2027. ⟳ Windows are set annually: https://www.nbme.org/news/2026-nbme-fee-assistance-program-for-usmle-opens-applications/ ↩ ↩2

  3. AAMC, 2027 ERAS residency timeline. Applicants may begin submitting on 2 September and programs begin reviewing applications on 23 September 2026; the MSPE is released to programs on the same day review opens. Read 2026-08-11. Dates shift by a few days each season, so confirm the current year's timeline rather than working from this one. https://students-residents.aamc.org/eras-tools-and-worksheets-residency-applicants/2027-eras-residency-timeline ↩

  4. USMLE Bulletin of Information, scoring and score reporting. Read 2026-08-11. Verbatim: "Results are typically available two to four weeks after your test date," and, in the same section, "When selecting your test date and inquiring about results, you should allow at least eight weeks to receive notification that your score report is available." The eight-week figure is the one to plan against, because it is the number the USMLE itself uses when telling you how to choose a date, and it is the one almost no study plan quotes. https://www.usmle.org/bulletin-information/scoring-and-score-reporting ↩

  5. Resource prices read from the vendors' own pages on 2026-08-11: UWorld Step 1 and Step 2 CK question banks, sold separately, at $349 / $459 / $519 / $579 for 30 / 90 / 180 / 360 days, with the Step 2 product including shelf-exam review in the same subscription; NBME self-assessment forms at roughly $62 each, sold individually with periodic bundle discounts. The preclinical resources referenced above are priced in the corresponding footnote on Surviving the Preclinical Years. https://medical.uworld.com/usmle/usmle-step-1/ · https://medical.uworld.com/usmle/usmle-step-2-ck/ · https://www.nbme.org/examinees/self-assessments ↩

  6. NRMP, Charting Outcomes in the Match, most recent edition published 28 July 2026. Organized by applicant group rather than as a single specialty table, and examines eleven to thirteen measures including Step 2 CK score, contiguous ranks in the preferred specialty, and counts of research, work, and volunteer experiences. https://www.nrmp.org/data-topic/applicant-competitiveness/?post_type=match-data ↩